Provider Demographics
NPI:1194925990
Name:EDINGER, NICOLE ANNE (OTRL)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNE
Last Name:EDINGER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2452
Mailing Address - Country:US
Mailing Address - Phone:610-739-0422
Mailing Address - Fax:
Practice Address - Street 1:7650 ROUTE 309
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2130
Practice Address - Country:US
Practice Address - Phone:610-282-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist